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      Clinical value of mammography in diagnosis and identification of breast mass

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          Abstract

          Objective:

          To study the effect and clinical value of mammography in the diagnosis of breast lump so as to improve the diagnosis level of breast cancer.

          Methods:

          A retrospective analysis was carried out on clinical data of 110 patients with mammary lump confirmed by pathology to study the compliance of mammography diagnosis and Pathology diagnosis in breast lump, and the detection of microcalcifications, phyllode, and observe the image performance of mammography. Taking infitrating ductal carcinoma (IDC) as an example, the correlation of image performance and clinical pathological features of different types was studied so as to predict if mammography performance was effective in the treatment and prognosis in breast cancer.

          Results:

          Taking Breast Imaging Reporting and Data System (BI-RADS) grade 4A as the critical point, the sensitivity, specificity and accuracy of mammography was 90.80% (109/120), 84.60% (126/149) and 87.40% (235/269); taking BI-RADS grade 4B as the critical point, the sensitivity, specificity and accuracy of mammography was 85.00% (102/120), 93.30% (139/149) and 89.60% (241/269); the correlation analysis suggested that, there was some kind of correlation between the mammography performance and clinical features of breast cancer.

          Conclusion:

          Mammography is worth being promoted in clinic for its significant clinical value in diagnosing and identifying breast lump.

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          Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy.

          Gale A Sisney, Lonie R Salkowski, Peter E Ochsner … (2007)
          To retrospectively evaluate whether microcalcification descriptors and the categorization of microcalcification descriptors in the Breast Imaging Reporting and Data System (BI-RADS) 4th edition help stratify the risk of malignancy, by using biopsy and clinical follow-up as reference standards. The institutional review board approved this HIPAA-compliant study and waived informed consent. The study included 115 women (age range, 26-82 years; mean age, 55.8 years +/- 10.5 [standard deviation]) who consecutively underwent image-guided biopsy of microcalcifications between November 2001 and October 2002. Screening and diagnostic mammograms (including magnification views) obtained before biopsy were analyzed in a blinded manner by a subspecialty-trained breast imager who recorded BI-RADS descriptors on a checklist. The proportion of malignant cases was used as the outcome variable to evaluate the ability of the descriptors to help capture the risk of malignancy. Fisher exact test was used to calculate the difference among the individual descriptors and descriptor categories. The positive predictive value of biopsy for malignancy was 21.7%. Each calcification morphologic descriptor was able to help stratify the probability of malignancy as follows: coarse heterogeneous, one (7%) of 14; amorphous, four (13%) of 30; fine pleomorphic, 10 (29%) of 34; and fine linear, 10 (53%) of 19. Fisher exact test results revealed a significant difference among these descriptor categories (P = .005). Significant differences among the risks suggested by microcalcification distribution descriptors (P = .004) and between that of stability descriptors (P = .001) were found. The microcalcification descriptors and categories in BI-RADS 4th edition help predict the risk of malignancy for suspicious microcalcifications. (c) RSNA, 2007.
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            The use of unenhanced Doppler sonography in the evaluation of solid breast lesions.

            Anthony Cura, Elena Elizagaray, Ana Legórburu … (2005)
            The objectives of our study were to investigate differences in Doppler sonography features between benign and malignant breast lesions and between malignant lesions with different prognostic factors and to propose diagnostic criteria for Doppler sonography of breast lesions. We performed power and duplex Doppler sonography examinations in 826 breast lesions scheduled for sonographically guided core needle biopsy. Lesion vascularity, pulsatility index (PI), and resistive index (RI) of the vessels detected were analyzed and correlated with histologic results. Color flow was more frequently seen in malignant (237/348 lesions, 68%) than in benign (171/478, 36%) lesions (p < 0.001). However, sensitivity, specificity, and positive and negative predictive values for this sign were low (68%, 64%, 58%, and 73%, respectively). The RI and PI values were significantly higher (p < 0.001) in cancers. Although an overlap in these values between benign and malignant lesions was observed, all but one nodule with an RI of greater than 0.99 (those with null or inverted diastolic flow) or a PI of greater than 4 were malignant. No significant relationship was found between PI, RI, or flow visualization on power Doppler sonography and tumor grade or lymph node involvement in cancers. Flow visualization on power Doppler sonography indicates a higher possibility of malignancy but is not useful as the main sign for malignancy. However, any lesion with a vessel that has an RI value greater than 0.99 or a PI value greater than 4 within it must be considered as probably malignant regardless of any other sonography sign present. Doppler findings are not useful to predict tumor grade or lymph node involvement.
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              The value of diffusion-weighted imaging in assessing the ADC changes of tissues adjacent to breast carcinoma

              Zhang Yili, Huang Xiaoyan, Du Hongwen … (2009)
              Background To define a threshold value of apparent diffusion coefficient (ADC) with which malignant breast lesions can be distinguished from benign lesions, and to evaluate the ADC change of peri-tumor tissue in breast carcinoma by echo planar-diffusion weighted imaging (EPI-DWI). Methods 57 breast lesions were scanned by routine MRI and EPI-DWI. The ADC values were compared between malignant and benign lesions. The sensitivity and specificity of EPI-DWI and the threshold ADC value were evaluated by Receiver Operating Characteristic curve (ROC). The ADC values of malignant lesion and layered peri-tumor tissues (from innermost layer 1 to outermost layer 4 with 5 mm every layer) in different directions were compared and the ADC values among different layers were compared. Results The ADC value of 35 malignant lesions was statistically lower than that of 22 benign lesions (P < 0.05). In ROC curve, the threshold value was 1.24 +/- 0.25*10E-3 mm2/s (b = 500) or 1.20 +/- 0.25*10E-3 mm2/s (b = 1000). The ADC value of malignant lesions was statistically lower than that of peri-tumor tissues in different directions (P < 0.05). For peri-tumor tissues, the ADC values increased gradually from layer 1 to layer 4 and there was a significant difference between the ADC values of layer 1 and layer 2 (P < 0.05); while from layer 2 outwards, there was no statistical difference among different layers. Conclusion ADC value was a sensitive and specific parameter that could help to differentiate benign and malignant breast lesions. ADC changes in tissues adjacent to breast carcinoma could be detected by EPI-DWI, which made EPI-DWI a promising method for helping to determine surgical scope of breast carcinoma.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pak J Med Sci
                Journal ID (iso-abbrev): Pak J Med Sci
                Title: Pakistan Journal of Medical Sciences
                Publisher: Professional Medical Publications (Pakistan )
                ISSN (Print): 1682-024X
                ISSN (Electronic): 1681-715X
                Publication date (Print): Jul-Aug 2016
                Volume: 32
                Issue: 4
                Pages: 1020-1025
                Affiliations
                [1 ]Hongjun Li, Department of Radiology, Binzhou People’s Hospital, Binzhou, Shandong, 256610, China
                [2 ]Shanhua Zhang, Department of Radiology, Binzhou People’s Hospital, Binzhou, Shandong, 256610, China
                [3 ]Qingyuan Wang, Department of Science and Education, Binzhou People’s Hospital, Binzhou, Shandong, 256610, China
                [4 ]Rongguang Zhu, Department of Radiology, Binzhou People’s Hospital, Binzhou, Shandong, 256610, China
                Author notes
                Correspondence: Shanhua Zhang, No. 515 Huanghe 7 th Road, Binzhou People’s Hospital, Binzhou, Shandong, 256610, China. E-mail: zshzzhangsh@ 123456163.com
                Article
                Publisher ID: PJMS-32-1020
                DOI: 10.12669/pjms.324.9384
                PMC ID: 5017071
                PubMed ID: 27648060
                SO-VID: 5adb9dde-6477-4725-8e5c-75a92662f393
                Copyright © Copyright: © Pakistan Journal of Medical Sciences
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 November 2015
                Date revision received : 13 January 2016
                Date revision received : 25 February 2016
                Date revision received : 05 June 2016
                Categories
                Subject: Original Article

                Keywords: mammography,breast cancer,breast imaging-reporting and data system-mammography,pathological diagnosis
                Data availability:
                Keywords: mammography, breast cancer, breast imaging-reporting and data system-mammography, pathological diagnosis

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